Abstract

Estrogen dermatitis is a rare type of dermatitis associated with cyclical skin eruptions pre menstrual cycle. We reported a 41 year old Saudi female who had
repeated visits to dermatology clinic because of skin eruption pre menstrual
cycle. Intradermal estrogen was tested and was Positive. Although this case is
rare, it should be considered in differential diagnosis as pre menstrual (cyclical)
dermatitis could be associated with estrogen hypersensitivity.

Keywords

Introduction

Oestrogen dermatitis is a rare skin disease, first described in
1995 [1]. It is characterized by skin eruptions in the form of
urticaria, eczema, papulovesicular lesion or pruritus [1,2]. The
condition is also characterized by its worsening with menstrual
cycles in patients of known estrogen hypersensitivity [2]. Oskay
summarized the criteria for diagnosis of estrogen dermatitis into
three; cyclic skin lesions related to the menstrual cycle, a positive
progesterone skin test or a positive oral/intramuscular challenge
to progesterone and demonstration of a circulating antibody to
the progesterone or basophil degranulation tests [3].

Case Report

A 41 year old Saudi female, medically free, came to our clinic
complained of about 10 years history of skin lesions that flare
with every pre menstrual cycle (Cyclical skin eruptions) and
relieved with menstruation. The skin rash was associated with
sever pruritus that interfere with daily activities. With every
pregnancy, the skin lesions disappeared completely and then
reappear back weeks after delivery. The skin lesions were mostly
on the extremities with Lichnifications, crustations and erosions
due to sever scratching (Figures 1 and 2).

Figure 1: Over the right ankle a lichnified erosive plaques.

Figure 2: Over the dorsum of right hand lichnified erythematous plaques.

No other skin lesions, no mucosal involvement. Intradermal
estrogen skin test was done and the reading after 30 minutes
showed positive results (Figure 3). The patient was given symptomatic treatment with anti histamine, mild to moderate
topical corticosteroid and improvement was complete.

Figure 3: Positive erythema at the site of intradermal estrogen injection.

Discussion

In 1995, Shelley [4], coined the term Oestrogen dermatitis.
They described women with premenstrual exacerbations of
various eruptions, including papulovesicular eruptions, urticaria,
eczema, and generalized pruritus. Their patients had positive
intradermal skin tests to Oestrogen and responded to tamoxifen
therapy. Since the original description, there have been a few
reports of the condition with varied treatment approaches,
including leuprolide acetate, progestin-only pill, and bilateral
oophorectomy and hysterectomy [5]. Our case is a presentation
of estrogen dermatitis, characterized by cyclical skin eruption
before each menstrual cycle, and relieved with menstruation and
pregnancy. The clinical presentation of estrogen dermatitis varied
and the histologic findings are nonspecific. However, it usually presents as a cyclic cutaneous disorder that may be urticarial, eczematous, popular or bullous and is usually characterized
by pruritus [3]. In general, there are no systemic symptoms or
complications associated with or autoimmune estrogen disease
other than none-specific symptoms such as pruritus, pain of
dyspigmentation with the cutaneous eruption [6].

Positive intradermal estrogen skin test was observed. A positive
reaction may be immediate (within 30 min) or delayed (24-96
h) [7]. No hormonal treatment was initiated only symptomatic
treatment with anti histamine, mild to moderate topical
corticosteroid was given. The patient completely recovered once
entered menopause. In conclusion, in cases where a female
comes to clinic with cyclical skin rash, estrogen dermatitis could
be considered as a cause for diagnosis.